宫腔镜检查对慢性子宫内膜炎的应用评价

目的 评价宫腔镜检查技术诊断慢性子宫内膜炎（chronic endometritis, CE）的应用价值。方法选择因女性不孕行宫腔镜检查并进行诊断刮宫术及组织病理学检查的患者418例，以组织病理学诊断标准作为金标准，评价宫腔镜下诊断CE的敏感度、特异度、阳性预测值、阴性预测值、准确度，绘制受试者工作特征（ROC）曲线，通过McNemar 2检验评价宫腔镜检查和组织病理学的阳性率差异有无统计学意义，一致性如何，并根据图片复习，寻找两种检查手段之间不一致的原因。结果（1）在418例不孕妇女宫腔镜检查中，全部进行了组织病理学检查，以子宫内膜间质在免疫组化染色下查见CD138阳性细胞为CE组织病理学诊断标准，病理学阳性为127例（发病率30.38%），其中有49例宫腔镜下诊断与病理学一致。（2）宫腔镜相对于病理学诊断CE，它的敏感度为38.58%，特异度为74.57%，阳性预测值为25.43%，阴性预测值为61.42%，阳性似然比为1.52，阴性似然比为0.82，准确度为63.64%。（3）ROC 曲线下面积为0.566，P<0.05；（4）根据图片复习，内膜轻度充血、单发微小息肉的病灶，稍显苍白水肿或血管增生等非特异图像是漏诊率最高的图像特征。结论宫腔镜检查与组织病理学未能达到满意的诊断一致性，无法替代组织病理学。宫腔镜检查医生需要更注意不典型的CE图像特征。

Diagnosis value of hysteroscopy for chronic endometritis

Objective To evaluate the value of hysteroscopy in the diagnosis of chronic endometritis (CE). Methods A total of 418 patients with female infertility who were performed with hysteroscopy, curettage and histopathological examination were selected. Taking the histopathological diagnosis criteria as gold standard, the diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy under hysteroscopy in the diagnosis of chronic endometritis were evaluated. ROC curve and McNemar Chi-square test were used to evaluate the statistical difference and consistency of positive rate of hysteroscopy and histopathology. According to the pictures, the reasons of inconsistency between the two methods were found.